Also referred to as the "Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse"

Who Is Covered

All Medicare beneficiaries are eligible for alcohol screening.

Medicare beneficiaries who screen positive (those who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence) are eligible for counseling if:

   • They are competent and alert at the time that counseling is provided; and

   • Counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

HCPCS/CPT Codes

G0442 - Annual alcohol misuse screening, 15 minutes

G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

ICD-10-CM Codes

No specific diagnosis code.

See the CMS ICD-10 webpage for individual Change Requests (CRs) and coding translations for ICD-10 and contact your Medicare Administrative Contractor (MAC) for guidance.

Frequency

Medicare covers one alcohol misuse screening per year. If your primary care doctor or other primary care practitioner determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary care doctor or other primary care practitioner must provide the counseling in a primary care setting (like a doctor’s office).

G0442 - One alcohol misuse screening per year

G0443 - For those who screen positive, 4 brief face-to-face counseling sessions per year

Medicare Beneficiary Pays

You pay nothing for this screening if the doctor or other qualified health care provider accepts assignment.

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

References